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Background: Back pain is a major health problem and many sufferers develop persistent symptoms. Detecting relevant subgroups of patients with non-specific low back pain has been highlighted as a priority area for research, as this could enable better secondary prevention through the targeting of prognostic indicators for persistent, disabling symptoms. We plan to conduct a randomised controlled trial to establish whether subgrouping using a novel tool, combined with targeted treatment, is better than best current care at reducing long-term disability from low back pain. Methods/Design: We will recruit 800 participants aged 18 years and over with non-specific low back pain from 8-10 GP practices within two Primary Care Trusts in Staffordshire, England. Our primary outcome measures are low back pain disability and catastrophising. Secondary outcomes include back pain intensity, global change, leg pain, fear avoidance, anxiety, depression, illness perceptions, patient satisfaction, overall health status and cost-effectiveness. Data will be collected before randomisation, and 4 and 12 months later. Participants are randomised to receive either newly developed interventions, delivered by trained physiotherapists and targeted according to subgroups defined by tool scores, or best current care. Discussion: This paper presents detail on the rationale, design, methods and operational aspects of the trial. Trial registration: Current Controlled Trials ISRCTN37113406. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the psychometric properties of the revised Illness Perceptions Questionnaire (IPQ-R) in adult participants with atopic dermatitis (AD). Two hundred and eighty-four participants who had a GP or dermatologist confirmed diagnosis of AD completed the IPQ-R. The factor structure of the IPQ-R was examined using confirmatory (CFA) and exploratory factor analysis (EFA). The results of the CFA did not indicate a good comparative fit with the IPQ-R subscales, while the EFA and a fixed six-factor principal components analysis largely replicated the original factor structure of the IPQ-R. The existence of the acute/chronic and cyclical timeline dimensions, and the illness coherence subscale was most strongly supported, while all items of the consequences and emotional representation subscales consistently loaded onto one factor. The EFA for causal attributions did not produce a stable solution. The findings indicate that although the factor structure of the IPQ-R was not confirmed in the sample of patients with AD using CFA, it was partly reproduced using EFA. Overall, the results suggest that in patients with AD the IPQ-R, in particular the consequences and emotional representations subscales, should be employed and interpreted with care.

Background: Occupational health guidelines recommend a biopsychosocial approach to manage sickness absence due to musculoskeletal disorders (MSDs), with a primary focus on early intervention through provision of a supportive network., Aims: To investigate the implementation of a guidelines-based intervention (early contact of absentees; addressing psychosocial obstacles; offering temporary modified work; communicating among the players), and to determine whether this is effective for reducing return-to-work times and duration of future absence., Methods: A non-randomized controlled trial was conducted within a UK company. Occupational health nurses at two experimental sites (1,435 workers) were trained to deliver the intervention to workers taking absence due to MSDs (low back and upper limb disorders), while usual care was delivered at three control sites (1,483 workers). Company-recorded absence data were collected over a 12-month follow-up period., Results: The implementation of the experimental intervention was impeded by unforeseen organizational obstacles at one site (policies, procedures and individual approaches) which had a detrimental effect on uptake and delivery. At the site where the intervention was delivered per protocol, absence was significantly less compared with controls; 6.5 and 10.8 days, respectively. However, the duration of future absence was not significantly different (13.0 and 25.1 days, respectively)., Conclusions: An early intervention addressing psychosocial obstacles to recovery can be effective for reducing absence due to MSDs. Successful implementation, where the key players are onside and organizational obstacles are overcome, is difficult to achieve.